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Neurocritical Care

, Volume 17, Issue 2, pp 191–198 | Cite as

The association between fluid balance and outcomes after subarachnoid hemorrhage

  • Ross P. MartiniEmail author
  • Steven Deem
  • Marcia Brown
  • Michael J. Souter
  • N. David Yanez
  • Stephen Daniel
  • Miriam M. Treggiari
Article

Abstract

Background

We sought to determine the association between early fluid balance and neurological/vital outcome of patients with subarachnoid hemorrhage.

Methods

Hospital admission, imaging, ICU and outcome data were retrospectively collected from the medical records of adult patients with aneurysmal SAH admitted to a level-1 trauma and stroke referral center during a 5-year period. Two groups were identified based on cumulative fluid balance by ICU day 3: (i) patients with a positive fluid balance (n = 221) and (ii) patients with even or negative fluid balance (n = 135). Multivariable logistic regression was used to adjust for age, Hunt-Hess and Fisher scores, mechanical ventilation and troponin elevation (>0.40 ng/ml) at ICU admission. The primary outcome was a composite of hospital mortality or new stroke.

Results

Patients with positive fluid balance had worse admission GCS and Hunt-Hess score, and by ICU day 3 had cumulatively received more IV fluids, but had less urine output when compared with the negative fluid balance group. There was no difference in the odds of hospital death or new stroke (adjusted OR: 1.47, 95%CI: 0.85, 2.54) between patients with positive and negative fluid balance. However, positive fluid balance was associated with increased odds of TCD vasospasm (adjusted OR 2.25, 95%CI: 1.37, 3.71) and prolonged hospital length of stay.

Conclusions

Although handling of IV fluid administration was not an independent predictor of mortality or new stroke, patients with early positive fluid balance had worse clinical presentation and had greater resource use during the hospital course.

Keywords

Cerebral aneurysm Delayed ischemic neurologic deficit Human Subarachnoid hemorrhage Cerebral vasospasm Triple-H therapy Hypervolemia Hypertension Hemodilution 

Notes

Acknowledgments

This study was performed at Harborview Medical Center, University of Washington, Seattle WA. This project was supported in part by the Washington State Society of Anesthesiologists and by departmental funds.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Ross P. Martini
    • 1
    • 2
    Email author
  • Steven Deem
    • 1
    • 3
    • 4
  • Marcia Brown
    • 1
  • Michael J. Souter
    • 1
    • 4
  • N. David Yanez
    • 5
  • Stephen Daniel
    • 5
  • Miriam M. Treggiari
    • 1
    • 4
    • 6
  1. 1.Department of Anesthesiology and Pain Medicine, Harborview Medical CenterUniversity of WashingtonWashingtonUSA
  2. 2.Department of Anesthesiology and Perioperative MedicineOregon Health and Science UniversityPortlandUSA
  3. 3.Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of WashingtonWashingtonUSA
  4. 4.Department of Neurological SurgeryUniversity of WashingtonWashingtonUSA
  5. 5.Department of Biostatistics, School of Public Health and Community MedicineUniversity of WashingtonWashingtonUSA
  6. 6.Department of Epidemiology, School of Public Health and Community MedicineUniversity of WashingtonWashingtonUSA

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